Welcome to Bizarro Amerika!

The most prominent efforts have been in Congress, where conservatives’ latest move has been to insist on holding the government budget process hostage to obtain cuts in funds intended for ACA implementation. But the most disruptive activity has been at the state level. Twenty-one states have refused to expand their Medicaid programs, blowing a large hole in the ACA’s coverage strategy. The Urban Institute estimates that 5 million people won’t get coverage as a result.

As The Post’s Sandhya Somashekhar reported last week, Republicans at the state level also have applied a variety of less visible measures to impede the law’s implementation. Some won’t enforce consumer protections, including a ban on insurance companies rejecting patients with pre-existing conditions. The result will be illegal discrimination. Another tactic has been restricting the work of federal “navigators,” consumer assistants who help people understand their options and get coverage. The result will be more people without health insurance.

Though some analysts offer explanations for why state governments might make one or another of these decisions, states taking these steps are unwise at best. To the extent they represent a deliberate policy to derail the law, such steps are worse than misguided. Georgia’s state government is doing “everything in our power to be an obstructionist,” Ralph Hudgens, the state’s insurance commissioner, boasted.

What they aren't intelligent enough to recognize is that people without health insurance facing emergencies are still going to get care...in emergency rooms. Which will cost the state and it's citizens far more.